Mental Health Court 101 2007 Georgia Drug & DUI Court Conference – Peachtree City, GA

1. Mental Health Court 101 2007 Georgia Drug & DUI Court Conference – Peachtree City, GA Honorable Kathlene Gosselin, Hall County Superior Court & H.E.L.P. Program Team

2. While the number of patients in psychiatric hospitals has decreased dramatically since 1955... • 1955 census included geriatric patients and some patients with MR • 21,000 (1/3) of the 70,000 patients in hospitals in 1995 were forensic patients • Does not include community or private hospitals Source: Torrey, Out of the Shadows, 1997

3. . . . jails and prisons have become the new “psychiatric hospitals”

4. Non-Traditional Allies • Police, judges, correctional officials have become strong allies of NAMI advocates in many states and communities. • Significant growth of pre and post-booking jail diversion programs, e.g. • CIT programs • MH Courts. • Enactment of federal legislation (P.L. 108-414).

5. Mental Health Courts • Treatment is better than jail. • For many of these offenders, mental illness is their primary issue, not criminality – not addressing the primary issue destines the offender to a revolving door at the jail. • Important differences from drug courts. • Psychiatric relapse is not a crime.

6. Similarities Ongoing judicial interaction Use of sanctions/incentives Integration of services with judicial case processing Non-adversarial approach of prosecution and defense Use of drug testing Coordinated strategy of court team Necessary coordination with community resources Differences Level and type of sanctions Court atmosphere Intensity of case management Lack of emphasis on payment of fees Judicial demeanor Inclusion of mental health system, consumer and advocacy partners Focus on medication compliance Need for treatment specific to co-occurring disorders Drug Courts vs. Mental Health Courts

7. Mental Health Program Principles • Divert persons with mental illness from unnecessary and inappropriate incarceration • Improve treatment access and recovery options • Reduce cost and risk for jail and law enforcement • Reduce recidivism and problem behaviors

8. Benefits of MH Courts • Help people with mental illness who are in the criminal justice system BECAUSE of their illness, out of jails and into treatment and more stable lives in the community. • Better treatment outcomes, reduced recidivism, enhanced public safety. • Provides options for other specialty courts (e.g. drug courts, domestic violence courts).

9. H.E.L.P Program • A pilot program of the Georgia Department of Corrections in partnership with the Hall County Superior Court • Services provided by MHM Correctional Services, Inc., a national vendor of mental health services to correctional systems and the current vendor to the Georgia Department of Corrections

10. Background • High recidivism rates for offenders with mental illness (16-18% in HCDC diagnosed MI) • GDOC desired pilot program to prevent the return to prison of offenders with mental illness • GDOC received grant from the Governor’s Criminal Justice Coordinating Council • Hall County selected as pilot site

11. Coordination • 18 months planning and coordination prior to start • Stakeholders attend training conference • Retention of vendor (MHM) • Development of service provider team and program procedures

12. Mission Statement It is the mission of the HELP Program to provide alternatives to incarceration for defendants who are involved in the criminal justice system as a result of their mental health or mental retardation issues. We accomplish this by linking those individuals to local, community based treatment resources with the goals of reducing recidivism and helping the participants become stable, productive members of the community.

13. Program Objectives • Provide offenders with community-based case management and treatment services as an alternative to incarceration • Stop the cycle of imprisonment of individuals with serious mental illness

14. Initial Program Staffing • Project Coordinator (licensed masters level) • Two full-time case managers (licensed masters level) • Half-time clinical psychologist (doctoral level)

15. Current Program Staffing • Project Clinical Coordinator (licensed masters level) • Clinical Case Manager • Community Support Person Additional Support: • Working with Georgia Mountains Community Service Board – GMCSB Team is similar in make-up • Psychiatric Social Worker • Community Support Individual • Access to psychiatric support and other therapeutic support

16. Eligibility Requirements • Incarcerated, charged, or on probation/parole in Hall County (Misdemeanor or Felony) • Not charged with one of seven serious or violent crimes (prosecutor consent required for enrollment) • Hall County residency • Voluntary participation • Criminal Adult Population

17. Eligibility Requirements Mental Health Criteria: • Severe and Persistent Mental Illness (psychotic disorders and major mood disorders) • Co-occurring Disorders • Mental Retardation • Other Axis I disorders that are primary to their involvement in the criminal justice system

18. Services Linkage and close supervision of: • Treatment – Inpatient/Outpatient • Counseling • Medication management • Vocational placement assistance • Housing placement assistance • Transportation linking • Length of program: 9 – 18 months or longer

19. Process • Referral: by police, attorney, DA, courts, probation, self-referral • Screening conducted by licensed staff • Assessment conducted for placement • Determination of suitability for program • Referral to HELP case management or declined services • Initiation of case management services • Court involvement • If not appropriate for Program – will be linked to services in community when possible to do so

20. Referral Sources • Hall County Public Defender Office 24% • Hall County Detention Center 23% • Private Attorneys 14% • Probation/Pretrial 13% • District Attorney/Solicitor 12% • Family/Self Referred 3% • Judicial 3% • Other 8% • (Defense Attorneys account for 37% of referrals)

21. Hall County, GeorgiaHELP Program Participants • Active 24 • Graduated 30 • Terminated 35 • Opted Out 8 • Enrolled (since inception) 97

22. Hall County, GeorgiaHELP Program - Jail Days 97 Participants: • Jail Days in 18 months prior to entry 7183 • AVG 74 • Jail Days while in Program 1333 • AVG 14 • Jail Days for 30 Graduates (in 18 months) 9 • Jail Days for 30 Grads (prior 18 months) 1759 • AVG 59

23. Hall County, GeorgiaHELP Program – Cost Benefit • These 92 persons spent 7183 days incarcerated in the 18 months prior to program entry, costing $359,150 in jail costs alone (does not include costs associated with officers dealing with issues these offenders caused while incarcerated, medical staff costs, transportation costs, or other jail related costs other than standard cost for an offender per day of $50)

24. Hall County, GeorgiaHELP Program – Cost Benefit • Jail Costs for participants in 18 months immediately prior to entry $ 359,150 • Active participants have spent 1333 days in jail while active in program $ 66,650 • 30 Graduates have spent 9 days in jail $ 450 Program has been operational for 30 months and first graduation was 12/2005

25. Participants • 65% of women have been victims of trauma • Childhood physical/sexual abuse and/or adult abuse • Co-occurring • Nearly 60% have co-occurring substance abuse issues in conjunction with their mental illness diagnosis • 50% Female – Male

26. William M. Hall County Arrest Record: • Drunk in Public - 1996 • Convicted – Armed Robbery in 1998 - GDC from 6/11/98 until 3/23/05 • Committed Simple Assault 6/13/05 (1 day in jail); Probation Warrant 7/8/05 (7 days in jail) • Entered HELP 7/15/05 • 1 day in jail during program • Graduated 6/29/06 – 0 days incarcerated since graduation • Jail Days in 18 months prior to entry 447 • Jail Days in Program 1 • Jail Days since Graduation (9+ months) 0

27. Christie M.

28. Keys toSuccessful Diversion Programs • Fixed Point of Accountability • Sufficient Case Management Resources • 24/7 Staffing, On Call and On Site • Low Patient-to-Staff Ratios • Access to Full Range of MH/SA Services

29. Keys toSuccessful Diversion Programs • Safe, transitional housing • Job placement opportunities • Supportive law enforcement community • Focus on recovery • Certain discretionary resources

30. Governor’s Mental Health Diversion ProgramConceptual Model for Comprehensive Hall County Program

31. Successes and Challenges • Successes to-date • On-going challenges • Future of the program

32. Mental Health Court IssuesThe Great Unknowns • The issue of perception • The effect of medications • Learned helplessness • Identifying target behaviors • “½ the sanctions and twice the patience”

33. It Just Makes Sense 97 Participants: • Jail Days in 18 months prior to entry 7183 (AVG. 74) • Jail Days while in Program 1333 (AVG. 14) • Jail Days for 30 Graduates (in 18 months) 9 • Jail Days for 30 Grads (prior 18 months) 1759 (AVG. 59) • Jail Costs for participants in 18 months immediately prior to entry $ 359,150 • Active participants have spent 1333 days in jail while active in program $ 66,650 • 30 Graduates have spent 9 days in jail $ 450

34. Questions